Leadership, identifying as an intensivist and being yourself

About the author:

Mary Pinder is the Immediate Past President of CICM and is works as a specialist intensivist in Perth, WA. She has recently completed her Masters Thesis on Multiple attempts at a high-stakes postgraduate exam - exploring the impact of failure and how Trainees achieve success (2023).

If you’ve ever had supervisor feedback that you need to be more assertive and you were left wondering what that means, read on! I hope this article will resonate with you and be helpful whether you are a Trainee starting out on your ICU journey, a new Fellow developing your leadership skills, or a Consultant with responsibilities for supervising and mentoring.

Although our intensive care community is becoming more diverse, our leaders have been predominantly white males and the culture largely driven by metropolitan tertiary institutions. This has shaped our professional identity and the image of an intensivist, because of cognitive biases with a tendency to reward those we see as mirroring traits we see in ourselves. Our adaptive unconscious plays an important role in helping us recognise an unstable patient, or assessing the level of supervision a Trainee needs, but we also need to recognise that our unconscious or implicit biases can lead to prejudice, discrimination and bad decisions.

It may seem that some supervisors have a fixed image of a ‘good Trainee’ as someone who speaks loudly, asks a lot of questions and is a bit bossy. But what if you’re a quiet reflective person, who understands instructions the first time, and learns best by finding out the answers yourself? How do you make yourself appear “more assertive” if that’s not your natural style? And how does this translate into becoming a consultant – can you only be a good leader if your voice naturally carries from one end of the unit to the other? Well, the answer is obviously, ‘No!’ and a contrasting leadership style is epitomised by the humble servant leader.

Dan Cable in his article for the Harvard Business Review describes humble servant leadership as follows:

Servant-leaders have the humility, courage, and insight to admit that they can benefit from the expertise of others who have less power than them. They actively seek the ideas and unique contributions of the employees that they serve. This is how servant leaders create a culture of learning, and an atmosphere that encourages followers to become the very best they can.

Humility and servant leadership do not imply that leaders have low self-esteem, or take on an attitude of servility. Instead, servant leadership emphasizes that the responsibility of a leader is to increase the ownership, autonomy, and responsibility of followers — to encourage them to think for themselves and try out their own ideas.

This is a leadership style that represents the values we want for our intensive care community and underpins the culture we want for our specialty. The humble servant leadership style may also resonate with many of you, and you are most likely showing these traits in your day-to-day life, professionally and personally. Compassion, kindness, concern for others and honesty are all qualities that we should show for our patients and their families/whānau, and it’s no different when it comes to interacting with our colleagues.

If you can be genuinely interested in someone and want to know their story and where they are coming from, it does a lot for team spirit and sense of self. Every one of us needs to feel valued and appreciated for who we are, and what we do, and a little bit of recognition goes a long way.

As leaders, there may be a sense of needing to appear all-knowing and a fear of losing credibility in owning up to our shortcomings. Liz Molloy and Margaret Bearman have described the importance of ‘intellectual candour’ as a bridge between vulnerability and credibility. Acknowledging our failings and mistakes and recognising – and admitting – when we are in the wrong provides a platform for learning and is key to building trust.

Our professional identity and how we see ourselves as an intensive care clinician is shaped by the culture of our professional community. Professional identity is a complex concept, including psychosocial and socio-cultural aspects, and is determined by our personal characteristics, values and beliefs; our interaction with others including family members/whanau, mentors and colleagues, and the influence of social groups to which we belong or aspire to join.

The factors influencing the development of the professional self are represented in the figure below. Our professional identity may be defined simply as thinking, feeling and acting like an intensivist. A crucial step in developing our community of practice is growing leaders and role models who reflect the diversity of our Trainees and Fellows, and the broader community that we serve.


Image: Schematic representation of the factors influencing the development of professional identity (Adapted from Cruess et al)

Rudine Sims Bishop is an educator who is credited as being the mother of multicultural children’s literature. In 1990 she published an article entitled Mirrors, Windows and Sliding Glass Doors. In this article she described how books are sometimes windows, offering the reader views of worlds that may be real or imagined. These windows are also sliding glass doors that the reader can walk through into these worlds. Literature also transforms human experience and reflects it back to us and we can see ourselves and our lives as part of this experience. So, the window can also act as a mirror and in reading the reader is seeking self-affirmation.

If we expand this metaphor for our intensive care community of practice, future Trainees need to be able to look through a window and observe current Trainees and Fellows; they need to have self-affirmation and see themselves mirrored in these roles; and they need to have a door that slides open to allow them to enter and become a part of this community. In this way our professional identity can evolve beyond the stereotype of the extrovert white male, and embrace the diverse spectrum of leadership styles and allow each of us to be the leader and role model that we are.

References

Cable Dan. How humble leadership really works. In Power and Impact (HBR Emotional Intelligence Series) chapter 13. Harvard Business Review Press 2019.

Molloy E and Bearman M. Embracing the tension between vulnerability and credibility: ‘intellectual candour’ in health professions education. Medical Education. 2018; 53:32-41.

Monrouxe LV. Identity, identification and medical education: why should we care? Med Educ. 2010 Jan;44(1):40-9.

Cruess RL, Cruess SR, Boudreau JD, Snell L, Steinert Y. A schematic representation of the professional identity formation and socialization of medical students and residents: a guide for medical educators. Acad Med. 2015;90:718-25.

Bishop RS. Mirrors, windows, and sliding glass doors. Perspectives: Choosing and Using Books for the Classroom. 1990;6:ix-xi.